摘要
目的:进行外耳道胆脂瘤(EACC)分类,探讨广泛型EACC的临床和影像学特点及其手术治疗。方法:分析56例(58耳)EACC患者的临床资料,根据EACC侵及的范围分为局限型和广泛型。手术方式依据病变范围而定。术后随访1～6年。结果:31例局限型EACC患者中,无外耳道骨质破坏2例,有骨质破坏29例(31耳);25例广泛型EACC患者中,在颞骨内16例,至颞骨外9例。广泛型EACC的常见症状有:耳漏(25例)、耳痛(23例)、听力下降(22例)等;鼓膜完整23例,穿孔2例。病变累及乳突23例,鼓窦8例,鼓室2例,乙状窦骨壁5例,面神经管乳突段4例,颞颌关节2例。20例行改良乳突根治术,1例行听骨链重建术,4例行外耳道成形术。术后平均干耳时间为29 d,听力平均提高15 dB。24例无复发,1例复发。结论:将EACC分为局限型和广泛型有一定的临床意义。广泛型临床表现复杂,易误诊。术前高分辨颞骨CT扫描有助于确定病变范围,制定手术方案,改良乳突手术有利于术后听力提高。
Objective：To classify the external auditory canal cholesteatoma（EACC） by high-resolution temporal bone CT scans and the clinical findings of the patients,and to discuss the clinical and imaging characteristics and the surgical management of the extensive EACC.Method：A retrospective study was carried out among 56 patients（58 ears） with EACC and their clinical data were carefully analyzed.We classified EACC as the extensive type and the localized type.The operation strategy depended on the extent of lesion.All cases were followed up for 1 to 6 years after surgery.Result：There were 31 patients with localized EACC,2 with no bone erosion and 29（31 ears） with bone erosion within external auditory canal,and 25 patients with extensive EACC,16 with bone erosion of intratemperal bone and 9 with bone erosion of extratemperal bone.Among all the 25 patients with the extensive type,the most common symptoms were otorrhea,otalgia and hearing loss,with 25,23,22 cases,respectively.The tympanic membrane（TM） was intact in 23 patients and perforated in two.The mastoid air cells in 23 patients were involved by the lesion,as well as tympanic antrum in eight,tympanic cavity in two,sigmoid sinus bony wall in five,mastoid segment of facial canal in four,and temporomandibular joint in two patients.Twenty patients underwent modified radical mastoidectomy,only one underwent reconstruction of ossicular chain,and four underwent canaloplasty.The average time of ear dry after surgery was 29 days.The postoperative hearing was improved by an average of 15 dB.No recurrence except for one patient was found during the follow-up period.Conclusion：It was of important clinical significance to classify EACC as the extensive type and the localized type.The extensive EACC was misdiagnosed easily because of the complicated clinical manifestations.The classification was helpful for the diagnosis and the selection of surgery strategy of EACC.
出处
《临床耳鼻咽喉头颈外科杂志》
CAS
北大核心
2013年第10期468-472,共5页
Journal of Clinical Otorhinolaryngology Head And Neck Surgery
基金
武警总医院科研课题基金资助(No:WZ2007031)
关键词
胆脂瘤
外耳道
分类
临床特点
耳外科手术
cholesteatoma
external auditory canal
classification
clinical characteristics
otologic surgical procedures
